Low Back Pain: Accuracy of Red Flags in Diagnosing Serious Pathology

A systematic search by MEDLINE, PUBMED, EMBASE, Cochrane Library, and SCO-PUS from inception to January 2019 produced interesting results in patients presenting to emergency departments for low back pain (LBP). All together 41,320 patients were analyzed for urgent treatment of vertebral fractures, spinal cancer, cord/cauda equina compression, vascular pathologies and infections disorders.

Although findings support a much higher prevalence of serious spinal pathologies entering emergency departments than primary care practices, malpractice situations and poor treatment outcomes may be averted when IH providers have intakes and face to face verbal discussions that consider the most predictive red flags increasing the likelihood for a serious condition:

  1. Suspicion or history of cancer
  2. Intravenous drug use
  3. Indwelling vascular catheter
  4. Other infection site (epidural abscess)

Low back pain in the emergency room department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags, American Journal of Medicine https://www.ncbi.nlm.nih.gov/pubmed/31278933